The Role of the Integrated Digital Radiology System in Assessing the Impact of Patient Load on Emergency Computed Tomography (CT) Efficiency

Abstract

Time-critical management is of particular significance in the trauma and emergency setting, where intervals from patient arrival to diagnostic imaging and from imaging to radiology report are key determinants of outcome. This study, based in the Trauma and Emergency Unit of a large, tertiary-level African hospital with a fully digital radiology department, assessed the impact of increased workload on computerised tomography (CT) efficiency. Sequential, customised searches of the institutional radiology information system (RIS) were conducted to define two weekends in 2016 with the lowest and highest emergency CT workloads, respectively. The electronic RIS timestamps defining the intervals between key steps in the CT workflow were extracted and analysed for each weekend. With the exception of radiologist reporting time, workflow steps were significantly prolonged by increased workload. This study highlights the potential role of the integrated digital radiology system in enabling a detailed analysis of imaging workflow, thereby facilitating the identification and appropriate management of bottlenecks.

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“…The perceived value of radiology as a medical specialty now extends well beyond the realm of pure diagnostics and includes digital information management. 12 , 13 , 14 , 15 , 16 Numerous studies have documented the clinical benefits of the integrated picture archiving and communication system/radiology information system (PACS/RIS) in healthcare delivery, most notably the substantially higher productivity and efficiency, with lower consumable costs. 10 , 17 , 18 , 19…”

Factors Contributing to Computed Tomography Trauma Scan Times at a Tertiary Center: Improving Emergency Department Trauma Imaging Workflow Through Targeted Interventions

“…4 While multiple factors have been attributed to ED overcrowding, imaging turnaround times have often been cited both within the US health care systems and internationally. 3,[5][6][7] Therefore, prompt CT scanning and radiology reporting should be a priority in the ED trauma workflow to ensure optimal patient care while decreasing factors contributing to ED overcrowding. Furthermore, it was estimated that $15 to 20 billion of radiology's expenditures are unnecessary and avoidable but occur because of poorly timed studies or unnecessary duplicates.…”

“…Currently, few studies exist that examine time elements in CT scanning in the emergency trauma setting. 3,6,7,9 Of those studies, transportation time to the CT scanner is the most frequently evaluated. However, in other areas of imaging, factors such as performing technician and hospital setting have been identified as important predictors in imaging time fluctuations.…”

“…Emergency department (ED) overcrowding leading to longer lengths of stay and higher ED occupancy ratios have been linked to higher 10-day mortality rate 4 . While multiple factors have been attributed to ED overcrowding, imaging turnaround times have often been cited both within the US health care systems and internationally 3,5–7 . Therefore, prompt CT scanning and radiology reporting should be a priority in the ED trauma workflow to ensure optimal patient care while decreasing factors contributing to ED overcrowding.…”

“…To address barriers in trauma CT workflow in the ED, identifying the factors with the greatest impact is necessary. Currently, few studies exist that examine time elements in CT scanning in the emergency trauma setting 3,6,7,9 . Of those studies, transportation time to the CT scanner is the most frequently evaluated.…”